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Quinn : Date(MM/DD/YY) 1� o Body Art Inspection Report = y County of San Joaquin County,Environmental Health Department u, < 1868 E.Hazelton Ave.,Stockton CA 95205 Permit Number (209)468-3420 www.sioov.ora/ehd Permit Type Facility Name Address City Zip Code CT I-14VIn V Lail PermitlRegistration Holder Name Permit Exp.Date Total Time Inspection Type 7. _47 a RISK FACTORS AND INTERVENTIONS Risk factors are improper practices or procedures identified as contributing factors of cross-contamination. Interventions are control measures to prevent cross-contamination and transfer of pathogens from one person to another. In=In Compliance Out=Not in Compliance N/O=Not Observed N/A=Not Applicable COS=Corrected On Site ..,-lam. r -,�s ,.: (` O; a R N�t;I COS,IIAETICS CHINE ' ��CLEAtG/11N.0 STERIIZATIUN. . i ..r s , k._ �� SAE SA TI N wN In WQ 1. Autoclave is approved and effective-passed ❑ ❑ n N/0 18. Safe machine design ❑ ❑ &) integratortest N/A In N10 2. Process of cleaning,labeling,packaging and13 ❑ n NIO 19. Machines cleaned and disinfected between 11 El xv sterliziing items correct) NIA clients In 3. Autoclave loaded correctly/packages allowedton® n N/0 20. Parts replaced between clients-grommets, ❑ d NIA elastic bands,etc. In N/0 4. Integrators used/monthly sporetestllog P t SCR S O AMItWIOx4 INPQ maintained0 13 " In 0 5. Decontamination/sanitation area separate and ❑ ❑ N/0 1 21. Workstation/procedure area decontaminated 13 11 supplied* NIA n N!0 6. Invoices and log kept for disposable,pre- ❑ ❑ n N/0 22. Chemical disinfect s t used` 11N/A sterilized ui ment,backu su lies available* N/A Chemical used: 13 In N/0 7. Sharps containers supplied,labeled,used and ® NIO 23. Disinfectant used sufficient contact time Wet ❑ ❑ N/A disposed of correct) * N/A contact timeprovided: In NIO 8. Jewelry,tattoo and piercing equipment-storage ❑ ❑ n NIO 24. Barriers available and used as part of 13 13A and use /A rocedure t � f n N!0 25. Products applied to skin are single ❑ ❑ . pRCTtT1tEli�ALT1 �IFiG1 N ,r ,� , !A use/disp ensed aseptically n NI0 9. No eating,drinking or smoking-clean clothes ❑ ❑ n N/0 26. Storage of Inks,pigments,needles,tubes,etc., ❑ ❑ NIA I WA qIfi 10 10. Hands washed effectively and timely ❑ ® n N/O 27. Jewelry,Inks,Needles etc approved and used ❑ 13 N/A n /0 11. Handwashing facilities properly supplied and 0 In N/0 28. Cross-contamination avoided during all phases 13 13A accessible,warm table water* NIA of procedure n /O 12. Personal protective equipment available ander BS� BiSI t:SS ) iGTIG �� N/A used,eyewash station available* ® ❑ ON NFUS OIU(ERS/ IE c In N!0 29. Areas separated/no living or sleeping ❑, n._.❑ uarters/no animals In NI 13. Branding is completed with no other customers in ❑ ❑ n 0 30. Floors and walls dean and in good repair, 0 procedure area NIA adequate light* 10 14. Customers eighteen(18)years of age or older ❑ ❑ /0 31. Workstation,surfaces,including chairs,,etc.in ❑ NIA /A good repair;trash removed frequently &N/0 15. Skin prepared for procedure. ❑ ❑ In N/0 32. Permittregistration and required signs posted* ❑ ❑ NIA N/A In NIO 16. Client records available-Consent form& ® In N/0 33. IPCP and employee training records and NIA questionnaire N/A Hepatitis B vaccination status present In N/0 17. Aftercare instructions given to client ❑ in NIO 34 Restrooms available,stocked* ❑ NIA NIA Received by(Print): Received by(Signature): Phone: Specialist(Print): Specialist(Signature): Phone: F1This report is an Official Notice of Violation.Corrections must be completed in the time specified. A reinspection fee may be charged if violations noted on this report are not corrected by the reinspection date. Reinspection Date(on or about) Page f_